Wednesday, November 17, 2010

Electronic Records: Somebody's Listening

In previous posts--http://brodyhooked.blogspot.com/2010/09/more-on-ehrs-and-safety.htmlhttp://brodyhooked.blogspot.com/2010/08/are-electronic-health-records-medical.html--I looked over at the field of health information technology to see if there were parallels with some of the issues we face in connection with pharmaceuticals. The initial reports were worrisome. After notable success with the first generation of "home grown" electrionic health records (EHRs), software firms saw a market for off-the-shelf records systems that they could peddle to hospitals and doctors' offices. In the process they often failed to debug the system or to address the criticial software-user interface issues, so that we began to hear increased reports of patient harm or risk resulting from the implementation of flawed EHR products. Yet the politicians continued to extol the EHR as if it could do no wrong and would solve all the cost and quality problems in health care. The Obama Administration seems poised to pour billions into EHRs with minimal attention to quality control.

Hence I was delighted to see an e-mail from my esteemed Michigan colleague and EHR expert, Dr. Scott Monteith:

"I’m in DC at the American Medical Informatics Association (AMIA) meeting... [S]uffice [it] to say that the medical informaticists/HIT experts are tempering their enthusiasm for HIT, with many questioning ... HIT safety/efficacy, etc ... For example, there was a standing-room-only debate addressing this question: are EHRs safe and effective? After the debate the audience of largely medical informaticists voted NO, they are not. "

Dr. Monteith here describes an important shift in opinion. Most of the physicians who became "early adopters" of EHRs were passionate about the potential advantages and initially were very reluctant to voice any concerns. The few who became the pioneer nay-sayers were often treated as outcasts. Yet now the concerns are fast becoming mainstream.

My personal story is that during the last 5 years I was actively seeing patients, 2001-2006, my academic family practice group used an electronic record that we researched carefully before purchasing. Our experience was overall highly positive, and I came away quite enamored of the advantages of EHRs and was a bit slow on the uptake to recognize the downside. So I am far from being an opponent of the EHR myself. But, to repeat my previously posted comment, a software company that starts to sell EHRs must acknowledge that it just became a medical device manufacturer, and whatever the ethics are of selling software to take the redeye out of your home snapshots, medical devices are a different matter entirely and the responsibility for safety and quality just went up by a factor of 10 or 100. Fortunately at least the docs heavily involved with HIT/EHRs are starting to get this message.